Vlaeyen Johan W S, De Jong Jeroen R, Onghena Patrick, Kerckhoffs-Hanssen Maria, Kole-Snijders Ank M J
Maastricht University, The Netherlands.
Pain Res Manag. 2002 Fall;7(3):144-53. doi: 10.1155/2002/493463.
Although cognitive-behavioural treatments of patients with chronic pain generally are reported to be effective, customization might increase their effectiveness. One possible way to customize treatment is to focus the intervention on the supposed mechanism underlying the transition from acute to chronic pain disability. Evidence is accumulating in support of the conjecture that pain-related fear and associated avoidance behaviours are crucial in the development and maintenance of chronic pain disability. It seems timely to apply this knowledge to the cognitive-behavioural management of chronic pain. Two studies are presented here. Study 1 concerns a secondary analysis of data gathered in a clinical trial that was aimed at the examination of the supplementary value of coping skills training when added to an operant-behavioural treatment in patients with chronic back pain. The results show that, compared with a waiting list control, an operant-behavioural treatment with or without pain-coping skills training produced very modest and clinically negligible decreases in pain-related fear. Study 2 presents the effects of more systematic exposure in vivo treatment with behavioural experiments in two single patients reporting substantial pain-related fear. Randomization tests for AB designs revealed dramatic changes in pain-related fear and pain catastrophizing. In both cases, pain intensity also decreased significantly, but at a slower pace. Differences before and after treatment revealed clinically significant improvements in pain vigilance and pain disability.
虽然据报道，对慢性疼痛患者进行认知行为治疗总体上是有效的，但个性化定制可能会提高其疗效。一种可能的定制治疗方法是将干预重点放在从急性疼痛向慢性疼痛残疾转变的假定机制上。越来越多的证据支持这样一种推测，即与疼痛相关的恐惧及相关回避行为在慢性疼痛残疾的发展和维持中至关重要。将这一知识应用于慢性疼痛的认知行为管理似乎是适时的。本文介绍两项研究。研究1涉及对一项临床试验中收集的数据进行二次分析，该试验旨在检验应对技能训练添加到慢性背痛患者的操作性行为治疗中时的附加价值。结果表明，与等待名单对照组相比，接受有或没有疼痛应对技能训练的操作性行为治疗后，与疼痛相关的恐惧仅有非常轻微且临床上可忽略不计的降低。研究2呈现了对两名报告有严重疼痛相关恐惧的患者进行更系统的体内暴露治疗及行为实验的效果。AB设计的随机化检验显示，与疼痛相关的恐惧和疼痛灾难化思维有显著变化。在这两个案例中，疼痛强度也显著降低，但速度较慢。治疗前后的差异显示，在疼痛警觉性和疼痛残疾方面有临床上显著的改善。
